Effectiveness of Recovery High Schools as Continuing Care Project Summary. This project will evaluate the effectiveness of Recovery High Schools (RHSs) for improving the behavioral and academic outcomes of adolescents with substance use disorders (SUDs) after receiving treatment. RHSs offer a full-range of academic services but also provide a structured environment promoting recovery. Key features include maintenance of a drug-free learning environment with post-treatment support and continuing care. No rigorous services research on the effectiveness of recovery schools has been conducted to date. The overall question to be addressed in this research is whether RHSs are more effective than regular high schools--combined with usual continuing care support services--in preventing relapse, facilitating academic achievement, and reducing dropout for students recovering from SUDs. The specific aims of this research are to assess whether students who are receiving or have completed treatment for substance use disorders have significantly better behavioral (less alcohol and other drug use, fewer mental health symptoms, less delinquent behavior) and educational (higher GPA, higher standardized test scores, better attendance, lower drop-out rates) outcomes if they attend recovery high schools for at least part of the school year compared to similar recovering students who attend regular high schools. The cost benefit of RHS will be estimated, outcomes for sub-groups (gender, ethnicity, age, treatment history, co- occurring disorder) assessed;presumed agents of change examined as moderators or mediators of the effects of RHS;and characteristics of schools influence on outcomes will be analyzed. The study will be conducted in Minneapolis/Saint Paul due to the high concentration of RHS in the area. Students (initial n=1370) will be recruited from substance abuse treatment facilities over three years and followed for 12 months. A comparison group of students not attending RHS will be selected using propensity score techniques. Hierarchical linear models that represent treatment providers as a blocking factor and account for nesting of students within schools will analyze the effects of attending a RHS. A secondary comparison group using existing follow-up data from a large national sample (about 18,000) of adolescents will be selected and analyzed with similar modeling. Descriptive data will be collected on the nature of the RHS programs and programs at the traditional high schools to support recovering students. A cost-benefit analysis will compare the recovery high school cost with the benefits of whatever reduced substance use and improved academic performance is found. This services research will build an evidence base on whether RHSs provide a cost-beneficial model of continuing care for adolescents with substance use disorders, and the data may support RHSs expansion by the collaboration of treatment programs, school districts and/or state agencies. PUBLIC HEALTH RELEVANCE: Substance use disorders (SUDs) not only have adverse effects on the health and safety of the affected youth, but also carry high societal costs. Substance use during adolescence is associated, for example, with high rates of morbidity and mortality due to risk-taking, assaults and motor vehicle crashes, delinquent behavior, unsafe sex, poor academic performance, and school drop-out. According to the National Survey on Drug Use and Health, approximately 144,000 adolescents per year receive treatment for drug or alcohol problems (SAMHSA, 2009), which represents less than 10% of the two million youths annually in the U.S. aged 12 to 17 who meet the diagnostic criteria for SUDs. While large sums are spent on treatment, the current system of care does not provide adequate and effective continuing care for adolescents;treatment outcome studies for adolescents show about a 40 - 60% relapse rate by one year (Winters et al, 2007). Prevalence of SUDs rises through teen years and peeks between ages 18 and 20, and recovery from SUDs is marked by chronic cycles of recovery and relapse (Dennis &Scott, 2007). The proposed services research will rigorously assess the effectiveness and cost benefit of providing recovery high school services to young people to support the gains they achieve in treatment, with a potentially very significant benefit in improving health and reducing the societal burden.